In 2010, Radiology, Inc., a radiology group based in Mishawaka, Ind., entered into contract negotiations with one of its client hospitals. During these talks, a startling fact came to light: Referring clinician partners at the hospital considered the group little more than a collection of image readers, and for that reason the perception was that they could easily be replaced if they didn’t accept the hospital’s terms.

Identifying a serious perception gap, Samir B. Patel, MD, FACR, Radiology, Inc. Value Management Program founder and director, set to work developing a data visualization tool to capture the non-interpretive relative value unit (RVU) activities undertaken by his group. Patel, who also serves as a member of the board of directors at Beacon Health System — the region’s largest locally owned and operated nonprofit healthcare system — developed the Radiology Value-Added Matrix to share achievements and goals with not only the practice’s executive board but also with their hospital client’s CEO and other members of the C-suite.

During a recent interview with the Bulletin, Patel reflected on the nearly 10 years since fully implementing the matrix and the more than 100,000 hours of value-added work that he and his colleagues have been able to document — equating to around $25 million in value.

Can you describe what the Radiology Value-Added Matrix is and what it’s used for?

Radiologists perform so many activities unrelated to image interpretation, especially now compared to 10 years ago. So, how do you succinctly capture, synthesize, define, and categorize all the things that radiologists do? The Radiology Value-Added Matrix was developed to compile all of the services we provide beyond image interpretation in a way that helps clients understand the value we bring to the healthcare enterprise.

What was the original impetus behind the matrix? What problem were you trying to solve?

Unfortunately, not only in medicine but in life, sometimes innovation is required during times of crisis. So, for us, even though our practice members have always engaged in a range of activities, back in 2010, the perception of hospital leadership and members of the medical staff was that we’d simply come in, interpret images, and go home. This made us look like an easily replaceable commodity. The matrix was a way to demonstrate the value we were generating through activities of which our care partners were unaware.

When I shared the first matrix with hospital and medical leaders in 2012, they were taken aback because they didn’t realize we were doing so many things beyond image interpretation. Ever since then, we’ve showcased an annual report — including the matrix — to key C-suite members across all of our client hospitals. We’ve come a long way because the CEO of Beacon Health System has come to look forward to the report every year.

How has the matrix helped you change referring physicians’ and administrators’ perceptions over time?

Continuous innovation is so important. This is where we fell short a decade ago. The annual meeting we schedule with key stakeholders to share the matrix is a way to gain access to members of the C-suite in ways that just weren’t open to us before. Trust is so hard to gain and is easily lost, and I believe we’ve gained the trust of our physician partners and hospital administrators primarily by building on our successes and documenting them in the matrix.

How has the matrix evolved since you first introduced it, and what impact has it had on your practice?

Nothing ever stays the same. As the world changes, radiology will need to change, too. In keeping with this, over the past 10 years we’ve added a few new categories and cut others. For instance, we now have a category on physician well-being, along with others dedicated to diversity and population health. Furthermore, peer review has transitioned to peer learning. We decided to make this latter change because we wanted to foster a just culture in which errors and near-miss events are evaluated in a deliberately nonpunitive framework. This helps us avoid a culture of blame so that we can instead focus on error prevention and encourage a culture of continuous quality improvement. Peer learning is an expression of just culture for radiologists.

It’s also important to note that the matrix was never meant to be stagnant or a one-size-fits-all program. It can be tailored to each individual practice, but it should also reflect what is important in radiology at a particular point in time.

Given the growing importance of value-based care in medicine, how do you anticipate the matrix will help you demonstrate value — particularly in relation to shared-risk reimbursement arrangements?

There is so much involved in imaging beyond interpretation — such as accreditation, follow-up, tracking adverse events, and utilization management. If done well, these activities can position radiology to become a valuable partner in risk-sharing arrangements. On the output side, being able to collect data related to how imaging is impacting patient outcomes through the lens of population health or utilization management can be equally important when entering into shared-risk arrangements. Collecting all of this information in one place — like a Radiology Value-Added Matrix — can help a practice when it comes time for these kinds of negotiations.

What is the first step someone should take if they want to develop a Radiology Value-Added Matrix?

Because radiology is involved in so many touchpoints in the healthcare ecosystem, our specialty is ideally suited to adopting and iterating on this concept. When considering whether to develop their own matrix, radiologists or practices should start by listing the most common activities they’re involved in that aren’t related to a billable CPT^® code. Time spent attending meetings and conferences are two such categories. Most practices utilize scheduling software, which can be used to extract this kind of data. If this works well, try to add one new non-image-interpreting task every two to three months and track it.

While you’re doing this, also consider how to quantify these activities in a way that the C-suite will easily understand, i.e., in terms of dollars (read the case study to learn how a practice converts these activities into dollar amounts). Following these steps will allow you to demonstrate your value without necessarily asking practice members to do much more work than they’re already doing — thereby gaining their buy-in.

What is the future of your Radiology Value-Added Matrix?

If the last two years have shown us anything, it’s that no one knows what the future holds. While I don’t have a crystal ball, I can definitely say that it’s important to stay nimble. The matrix helps us do just that. We will continue building in time to periodically reflect on our non-interpretive RVU activities to evaluate whether or not we need to change anything. And we’ll continue to think of it not as written in stone but as a living, working, breathing document.